Resuscitation
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Quality of cardiopulmonary resuscitation (CPR) performed by professionals is reported to be substandard even with automated corrective feedback. We hypothesised that lack of quality is not due to physical capabilities. ⋯ Ambulance personnel were physically capable of consistently compressing to the Guidelines depth even on the stiffest chest. These laboratory results cannot be directly compared to the clinical out-of-hospital ALS situation, but strongly indicate that the inadequate chest compressions found in our clinical study were not due to lack of physical capability. We speculate that this may at least partly be explained by their fear of causing patient injury and trust in their own opinion of what is the correct compression depth and force in preference to the feedback.
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The death of a close family member is one of life's greatest tragedies. When death is sudden and unexpected, there is an increased risk of posttraumatic reactions and complicated mourning. Care of the bereaved is still often overlooked in medical training and clinical practise. ⋯ Four factors were identified as being particularly important for the parents: evidence, reconstruction, explanation and sensitivity. There is a need of better routines to help the suddenly bereaved. A model of the major needs and a plan for the support needed are proposed.
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To study out-of-hospital cardiac arrests (OHCA) occurring in primary healthcare facilities (HCF) in Singapore and to compare these with arrests occurring in the community. ⋯ This study suggests that primary health care providers do have an important role locally in managing out-of-hospital cardiac arrest. We propose an initiative to encourage early defibrillation by primary health care providers.
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Telephone cardiopulmonary resuscitation (CPR) advice aims to increase the quality and quantity of bystander CPR, one of the few interventions shown to improve outcome in cardiac arrest. We evaluated a current telephone protocol (based on 2000 ILCOR guidelines) to assess the effectiveness of verbal CPR instructions. ⋯ Although current telephone-CPR instructions significantly improve the numbers of patients in whom bystander CPR is attempted, significant delays and poor quality CPR are likely to limit any benefits.
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Sepsis is a severe inflammatory disorder that may lead to multiple organ failure. Lipopolysaccharide (LPS) is associated with Gram-negative sepsis and can activate monocytes and macrophages to release pro-inflammatory mediators such as tumor necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and anti-inflammatory mediator such as interleukin-10 (IL-10). In this present study, we used fluvastatin, a HMG-CoA reductase inhibitor, to study its effects upon LPS-induced endotoxic shock in conscious rats. ⋯ Pre-treatment with fluvastatin suppresses the release of plasma TNF-alpha, increases plasma IL-10, and NO production, and decreases the levels of markers of organ injury associated with endotoxic shock, so ameliorating LPS-induced organ damage amongst conscious rats.